Most of us have followed the news watching the roll out of the changes under the ACA. Many have waited in anticipation of getting insurance coverage, which they had not been able to afford in the past. But for many, the hope was quickly dissipated. Many people had difficulty just trying to reach the site to enroll under the new insurance exchanges. And others found that the cost was too prohibitive and they preferred to face the tax penalties. It came as a shock for some when they presented their new insurance cards, only to learn that they had to pay very high deductibles before their insurance kicked in. While the ACA was proclaimed to cut healthcare costs and get the uninsured covered, it has failed these goals in many respects. So, who has profited from the ACA?
Why commercial insurance plans are the biggest winners under the ACA?
– They are collecting unprecedented number of premiums. Many people are paying these premiums even though they do not want to. They feel coerced into it because they wish to avoid a tax penalty. There is no government oversight to how much these health insurances can charge. While now the market is very competitive, I expect costs to rise as the market gets saturated.
– They are paying out less for medical services. Virtually all the plans I have seen, require the patient to pay a high deductible before they pay for any services. Many patients are forgoing care just because they cannot afford both their new premiums and the deductibles. In many cases these deductibles are quite high and the chances that the insurance company will pay out anything will be minimal.
– Medicaid is increasingly enrolling those eligible through HMO’s via the insurance exchanges. Not only are these exchanges getting private dollars, they are now collecting state money. Where I practice, there are very few patients who have only Medicaid not issued through a HMO.
– Private insurance is for profit. They can collect as much money as they want. They are incentivized to collect more and pay out less. The more money they make, they more money they can keep for themselves.
– Unlike Medicare and Medicaid, there is little oversight over these private insurance companies.
While many proclaim the goodness of the ACA getting insurance for the uninsured, it is not without its faults. Sure, more people are insured but they are being insured by paying more money out of their own pockets. Many of them are struggling to make these premiums and are further frustrated by the fact they are unable to see the doctor due to high deductibles. So, despite having insurance, many simply can still not afford to come for medical care. The people the ACA is supposed to be helping, the patient, are being more squeezed by it in many ways. The healthcare system is in need of reform. But, not at the cost of the patients it is supposed to be helping and not at the profit of those who have motivation to make money off of denying care. The ACA needs to be re-evaluated and real healthcare reform needs to be implemented. Perhaps, it is time to reform the for profit insurance companies.
